Do thyroid-stimulating hormone, body weight, or body mass index serve as adequate markers to guide levothyroxine dose titration?

[helvella]

Just saw this:

J Am Coll Surg. 2013 Oct;217(4):752-3. doi: 10.1016/j.jamcollsurg.2013.06.008.

Do thyroid-stimulating hormone, body weight, or body mass index serve as adequate markers to guide levothyroxine dose titration?

Dietrich JW, Leow MK, Goede SL, Midgley JE, Landgrafe G, Hoermann R.

Source

Bochum, Germany.

PMID: 24054412

ncbi.nlm.nih.gov/pubmed/240...

journalacs.org/article/S107...

In case any of the authors' names look at all familiar, have a look here:

thyroiduk.org.uk/tuk/About_...

It would be good if we could see more than this heading-only - even if it is only a few paragraphs in response to some other paper!

Rod

[lola1956]

so what doe this all mean then?

[helvella Administrator Thyroid UK in reply to lola1956]

Until we see what was said, not a lot.

My main motivation in posting was to draw to everyone's attention that three of our medical advisers have collaborated in writing a published paper. That represents a closeness between TUK - representing patients and the authors which is at least towards unprecedented.

[PR4NOW]

Rod, nice find, where did you find the pictures and bio's? PR

[helvella Administrator Thyroid UK in reply to PR4NOW]

On the main Thyroid UK site! They have been there for some time now - since these good people agreed to the roles.

[SilkyJ]

Here is the abstract journalacs.org/article/S107... :

Using Body Mass Index to Predict Optimal Thyroid Dosing after Thyroidectomy

Abstract presented at the American College of Surgeons 98th Annual Clinical Congress, Chicago, IL, October 2012.

Kristin A. Ojomo, PA, David F. Schneider, MD, MS, Alexandra E. Reiher, MD, Ngan Lai, BA, Sarah Schaefer, NP, Herbert Chen, MD, FACS, Rebecca S. Sippel, MD, FACSemail address

Received 18 October 2012; received in revised form 4 December 2012; accepted 4 December 2012. published online 14 January 2013.

Abstract Full Text PDF Images References

Background

Current postoperative thyroid replacement dosing is weight based, with adjustments made after thyroid-stimulating hormone values. This method can lead to considerable delays in achieving euthyroidism and often fails to accurately dose over- and underweight patients. Our aim was to develop an accurate dosing method that uses patient body mass index (BMI) data.

Study Design

A retrospective review of a prospectively collected thyroid database was performed. We selected adult patients undergoing thyroidectomy, with benign pathology, who achieved euthyroidism on thyroid hormone supplementation. Body mass index and euthyroid dose were plotted and regression was used to fit curves to the data. Statistical analysis was performed using STATA 10.1 software (Stata Corp).

Results

One hundred twenty-two patients met inclusion criteria. At initial follow-up, only 39 patients were euthyroid (32%). Fifty-three percent of patients with BMI >30 kg/m2 were overdosed, and 46% of patients with BMI <25 kg/m2 were underdosed. The line of best fit demonstrated an overall quadratic relationship between BMI and euthyroid dose. A linear relationship best described the data up to a BMI of 50. Beyond that, the line approached 1.1 μg/kg. A regression equation was derived for calculating initial levothyroxine dose (μg/kg/d = −0.018 × BMI + 2.13 [F statistic = 52.7, root mean square error of 0.24]).

Conclusions

The current standard of weight-based thyroid replacement fails to appropriately dose underweight and overweight patients. Body mass index can be used to more accurately dose thyroid hormone using a simple formula.

Abbreviations and Acronyms: BMI, body mass index, LBM, lean body mass, LT4, levothyroxine, TSH, thyroid-stimulating hormone, WBD, weight-based dosing

[helvella Administrator Thyroid UK in reply to SilkyJ]

SilkyJ,

The link you posted has, unfortunately been mangled by the round-trip from screen to HU and back.

This shortened URL should work:

tinyurl.com/TUK-HU-BWT

That is also not the paper I posted about - title and authors are different.

Rod

[helvella Administrator Thyroid UK in reply to helvella]

The original paper is one of those I used to produce the spreadsheet I have posted several times.

Here:

dl.dropboxusercontent.com/u...

[SilkyJ in reply to helvella]

Sorry Rod. I got no notification that you had responded. Yes, I see I posted a different study. Apologies for my mistake! I've been pretty poorly lately and seem to be making so many silly mistakes lately, which is extremely frustrating.

Silky

[helvella Administrator Thyroid UK in reply to SilkyJ]

No apologies needed!

We all make mistakes and I think the paper might cite the one you posted.

Hope you get going again very soon.

Rod